Health Evaluation Research Articles

Value of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score in predicting hospital mortality for postoperative brain tumor patients in intensive care units in Japan: A retrospective case-control study

ObjectiveAcute Physiology and Chronic Health Evaluation II (APACHE II) is based on the data of intensive care unit (ICU) patients and often correlates with disease severity and prognosis. However, no prognostic predictors exist based on ICU admission data for patients with brain tumors, and no studies have reported an association between APACHE II and prognosis in patients with brain tumors. The Japanese Intensive Care Patients Database (JIPAD) was established to improve the quality of care delivered in intensive care medicine in Japan. We used JIPAD to examine factors associated with in-hospital mortality based on available data of postoperative patients with brain tumors admitted to the ICU. MethodsPatients aged ≥16 years enrolled in JIPAD between April 2015 and March 2018 after surgical brain tumor resection or biopsy of brain tumors. We examined factors related to outcomes at discharge based on blood tests and medical procedures performed during ICU admission, tumor type, and APACHE II score. ResultsAmong the 1454 patients (male:female ratio: 1:1.1, mean age: 62 years) in the study, 32 (2.2 %) died during hospital stay. In multivariate analysis, male sex (odds ratio [OR] 2.70, [95 % confidence interval, CI 1.22–6.00]), malignant tumor (OR 2.51 [95 % CI 1.13–5.55]), and APACHE II score ≥15 (OR 2.51 [95 % CI 3.08–14.3]) were significantly associated with in-hospital mortality. ConclusionBy picking up cases with a high risk of in-hospital death at an early stage, it is possible to improve methods of treatment and support for the patient's family.

Association of the triglyceride–glucose index with all-cause and cause-specific mortality: a population-based cohort study of 3.5 million adults in China

The triglyceride-glucose (TyG) index has been recognized as a crucial risk factor for cardiovascular diseases. However, the association between the TyG index and mortality in the general population remains elusive. Participants were enrolled from the China Health Evaluation And risk Reduction through nationwide Teamwork (ChinaHEART), a nationwide prospective cohort study. The outcomes of interest were all-cause, cardiovascular, and cancer mortality. Restricted cubic splines and Cox regression models were used to assess the associations between the TyG index and outcomes. In total, 3,524,459 participants with a median follow-up of 4.6 (IQR, 3.1-5.8) years were included. The associations of the TyG index with all-cause and cardiovascular mortality were reverse L-shaped, with cut-off values of 9.75 for all-cause mortality and 9.85 for cardiovascular mortality. For each 1-unit increase in the TyG index, when below the cut-off values, the TyG index was not significantly associated with all-cause mortality (HR=1.02, 95% CI: 1.00-1.03) and was only modestly associated with cardiovascular mortality (HR=1.09, 95% CI: 1.06-1.11). Conversely, when the cut-off values were exceeded, the HRs (95% CI) were 2.10 (1.94-2.29) for all-cause mortality and 1.99 (1.72-2.30) for cardiovascular mortality. However, the association between the TyG index and cancer mortality was linearly negative (HR=0.97, 95% CI: 0.94-0.99). The associations of the TyG index with all-cause and cardiovascular mortality displayed reverse L-shaped patterns, while an elevated TyG index showed a slight negative association with cancer mortality. We suggest that <9.75 could be the optimal TyG index cut-off value among the Chinese general population. Individuals at high risk of mortality might benefit from proper management of a high TyG index. The National High Level Hospital Clinical Research Funding (2023-GSP-ZD-2, 2023-GSP-RC-01), the Ministry of Finance of China and National Health Commission of China.

Physical Education Teachers' Health Literacy: First Evidence from Lithuania.

Promotion of health literacy is an important goal in the context of promoting whole school health. Physical education teachers are of particular importance in achieving this goal. However, very limited empirical studies have addressed the health literacy of physical education teachers. This research aimed to test the structural validity and reliability of the HLS19-Q12, to measure health literacy among physical education teachers, and to evaluate associations of health literacy with health- and lifestyle-related indicators. We conducted a cross-sectional study of Lithuanian physical education teachers. The participants completed a self-administered online survey that collected information on socio-demographics and health literacy (HLS19-Q12 for general health literacy and the optional package HLS19-DIGI to measure digital health literacy) as well as health behavior. A total of 332 participants completed the survey. The HLS19-Q12 demonstrated acceptable internal consistency (Cronbach's α of 0.73 and McDonald's ω of 0.75) and satisfactory structural validity (CFI = 0.924, TLI = 0.917, RMSEA = 0.081). Participants had an average score of 85.09 (SD = 17.23) when using the HLS19-Q12, with 19.3% and 48.8% displaying excellent and sufficient levels of health literacy, respectively. Regression analyses revealed that a higher level of health literacy was significantly associated with better health evaluation (β = 0.15, p < 0.01), but no significant association was found with other health behavior and lifestyle indicators. Overall, the results suggest that teachers' general health literacy is relatively high. Our findings highlight the importance of conducting more in-depth studies to pursue the understanding of the whole school teachers' health literacy.

Regional challenges concerning derivation of suspended particulate matter concentration and water turbidity from water reflectance. A case study in the western Black Sea

Assessment of water quality indicators, such as Suspended Particulate Matter (SPM) concentration and water turbidity (TUR) is essential for marine ecosystems health evaluations. This work focuses on the estimation of these two variables from water-leaving reflectance measurements, either derived from in-situ observations or satellite data, for the western Black Sea basin. The regional characteristics of the water optically active constituents can have important impact on the quality of such estimations if not properly accounted for. We test several existing inversion algorithms and quantify their accuracy. New, regionally adapted methods are then proposed, together with a new formulation for a multi-conditional switching mechanism. Calibration of these models is performed based on SPM and TUR in-situ measurements. It is shown that the improvements achieved through regional adaptation can be significant. Application of these algorithms to Sentinel-3 OLCI satellite data reveals the consistency of the proposed methodology. Also, it shows the degree of uncertainty if improper formulations are used, with major impact on the absolute values of retrieved SPM or TUR.

High-flow nasal cannula oxygen therapy for mild-moderate acute respiratory failure in patients with blunt chest trauma: An exploratory descriptive study

ObjectiveThe use of high-flow nasal cannula (HFNC) oxygen therapy is gaining popularity for the treatment of acute respiratory failure (ARF). However, limited evidence exists regarding the effectiveness of HFNC for hypoxemic ARF in patients with blunt chest trauma (BCT). MethodsThis retrospective analysis focused on BCT patients with mild-moderate hypoxemic ARF who were treated with either HFNC or non-invasive ventilation (NIV) in the emergency medicine department from January 2021 to December 2022. The primary endpoint was treatment failure, defined as either invasive ventilation, or a switch to the other study treatment (NIV for patients in the NFNC group, and vice-versa). ResultsA total of 157 patients with BCT (72 in the HFNC group and 85 in the NIV group) were included in this study. The treatment failure rate in the HFNC group was 11.1% and 16.5% in the NIV group - risk difference of 5.36% (95% CI, −5.94–16.10%; P = 0.366). The most common cause of failure in the HFNC group was aggravation of respiratory distress. While in the NIV group, the most common reason for failure was treatment intolerance. Treatment intolerance in the HFNC group was significantly lower than that in the NIV group (1.4% vs 9.4%, 95% CI 0.40–16.18; P = 0.039). Univariate logistic regression analysis showed that chronic respiratory disease, abbreviated injury scale score (chest) (≥3), Acute Physiology and Chronic Health Evaluation II score (≥15), partial arterial oxygen tension /fraction of inspired oxygen (≤200) at 1 h of treatment and respiratory rate (≥32 /min) at 1 h of treatment were risk factors associated with HFNC failure. ConclusionIn BCT patients with mild-moderate hypoxemic ARF, the usage of HFNC did not lead to higher rate of treatment failure when compared to NIV. HFNC was found to offer better comfort and tolerance than NIV, suggesting it may be a promising new respiratory support therapy for BCT patients with mild-moderate ARF.

Evaluation of Child Oral Health Related Quality of Life in Bleeding Disorders

Abstract Background Oral bleeding is a common symptom for many inherited and acquired bleeding disorders in children. Understanding oral health and treatment needs of patients with bleeding disorders is necessary for patients' primary oral health prevention. Aim of the Work To evaluate the oral health problems in children with bleeding disorders both clinically and with child oral health related quality of life questionnaire score. To assess the effect of intervention (education and any necessary dental procedure) on the child oral health related quality of life questionnaire score. Patients and Methods This cross-sectional study was conducted on 70 patients aged from (2-18 years), males represent n = 47 (67.1%), females n = 23 (32.9%). Inherited bleeding disorders represent n = 37 (52.9%) and acquired bleeding disorders represent n = 33 (47.1%). ITP n = 33 (47.1%), hemophilia A n = 27 (38.6%), Von Willebrand’s disease n = 7 (10%) and Glanzmann n = 3 (4.3%) and all subjected to full history taking, examination, dental health estimation, oral health education, dental management and replacement therapy as needed at baseline and after 6 months of follow up from October 2021 to April 2022. ITP bleeding score (ISTH SSC bleeding assessment tool) used to assess severity of ITP patients. Child oral health related quality of life and child oral health impact profile questionnaires were filled by patients/parents at base line and after 6 months follow up. Results The current study revealed that (57.1%) of patients have dental caries. Regarding oral hygiene status, (10%) of patients have poor oral hygiene. Regarding gingival health, (50%) of patients have moderate gingivitis and (11.4%) have severe gingivitis. Oral symptomatology, Psychological domain for child, Psychological domain for family, Social domain for child and Total oral health score were significantly affected more with long duration of disease (p-value =0.0005, 0.0015, 0.010, 0.022 and 0.0045 respectively). There was statistically significant improvement in oral health related quality of life questionnaire score after 6 months of follow up with total oral health score (p-value = 0.000). Conclusion Oral health was significantly affected among patients with acquired and inherited bleeding disorders. Oral health education and management had significant impact on oral health related quality of life scores after 6 months of follow up.

Clarifying terminology and definitions in education services for mental health users: A disambiguation study.

In the wake of the mental health crisis in children and adolescents, the coordination of education and mental health services has become a global priority. However, differing terminologies and classifications across sectors, hinder effective comparison. The classification in education focuses mainly on outputs like qualifications or throughputs like teaching programs. This proof-of-concept study tested the applicability of a standard classification of health services, the Description and Evaluation of Services and DirectoriEs (DESDE), to evaluate education services for mental health users in the context of Spain and The Netherlands. It was conducted alongside the PECUNIA project, that sought to develop methods for the assessment of mental health costs and outcomes in different sectors. The study followed an ontoterminology approach involving: 1) identification of services from a predefined list of 46 resource-use items, 2) disambiguation of identified services with the DESDE, and classifying them as accurate, ambiguous, vague or confuse; and 3) external validation by an expert panel. The analysis was conducted at the level of type of resource, target population and care provision. From the initial list, only ten of the resources could be categorized as services using DESDE, and not activities, interventions or professionals. Only four of them (8,65%) were accurate across all disambiguation categories. Experts were unaware of terminology problems in classification of service provision in the education sector. Classifications and glossaries can clarify service naming, description and costing allowing comparative effectiveness analysis and facilitating cross-sectoral planning. This should be grounded in common methodologies, tools, and units of analysis.

Unpacking the complexities of health record misuse: insights from Australian health services

PurposeInformation systems (IS) research in general and health IS studies, in particular, are prone to a positivity bias – largely focusing on upside gains rather than the potential misuse practices. This paper aims to explore failures in health IS use and shortcomings in data privacy and cybersecurity and to provide an explanatory model for health record misuse.Design/methodology/approachThis research is based on four data sets that we collected through a longitudinal project studying digital health (implementation, use and evaluation), interviews with experts (cybersecurity and digital health) and healthcare stakeholders (health professionals and managers). We applied qualitative analysis to explain health records misuse from a sociotechnical perspective.FindingsWe propose a contextualized model of “health records misuse” with two overarching dimensions: data misfit and improper data processing. We explain sub-categories of data misfit: availability misfit, meaning misfit and place misfit, as well as sub-categories of improper data processing: improper interaction and improper use-related actions. Our findings demonstrate how health records misuse can emerge in sociotechnical health systems and impact health service delivery and patient safety.Originality/valueThrough contextualizing system misuse in healthcare, this research advances the understanding of ineffective use and failures in health data protection practices. Our proposed theoretical model provides explanations for unique patterns of IS misuse in healthcare, where data protection failures are consequential for healthcare organizations and patient safety.

PL03 EVALUATION OF PUBLIC HEALTH AND SAFETY POLICIES AT WORK

PL03 EVALUATION OF PUBLIC HEALTH AND SAFETY POLICIES AT WORK

Effects of family caregivers keeping a “Good Things Diary of Caregiving” on mental health, caregiving burden, and positive evaluations of caregiving: A randomized controlled trial

BackgroundWe explored the impact of writing a “Good Things Diary (GTDiary) of Caregiving” on family caregivers’ mental health and their evaluation of caregiving roles. MethodWe analyzed data from 27 Japanese caregivers for their parents recruited through crowdsourcing. We randomly assigned the participants to one of two groups: the GTDiary of Caregiving group (15 participants) or the Control Diary of Caregiving group (12 participants). We instructed both groups to write a diary for 14 days. Pre- and post-diary questionnaires assessed participants’ well-being, caregiving burden, positive evaluations of caregiving, and stress levels. ResultsWe observed significant improvements in well-being and positive evaluations of caregiving only in the GTDiary of Caregiving group, which had higher well-being and more positive evaluations of caregiving after keeping the diary. However, both groups experienced reductions in caregiving burden and stress. LimitationOur group of participants included children and stepchildren of caregivers since we made use of crowdsourcing services. Additionally, this study had a mostly male representation among participants, which does not match with the higher occurrence of female family caregivers in Japan. Consequently, the study's participants may not fully reflect the broader population of family caregivers. ConclusionsWriting a caregiving diary helps family caregivers reduce their perceived burden and stress. Focusing on “good things” in caregiving elevates their perception of positive aspects and enhances well-being.

Low incidence of deep vein thrombosis in critically ill medical patients in Thais: a prospective study

BackgroundCritically ill medical patients face a heightened risk of developing venous thromboembolism. In Thailand, routine thromboprophylaxis is not employed. The incidence of deep vein thrombosis (DVT) in the medical intensive care unit (ICU) has not been elucidated in the Thai population. ObjectivesThe aims were to evaluate the incidence of DVT and identify associated risk factors in critically ill medical patients. MethodsA single-center, prospective cohort study was conducted from 2019 to 2020. Consecutive patients underwent screening for proximal DVT by duplex ultrasound of both legs. ResultsA total of 200 patients were enrolled, with 115 being male (57%). The mean (SD) age was 66.5 (16.4) years. The mean (SD) Acute Physiology and Chronic Health Evaluation II score was 27 (8). The cumulative incidence of DVT over 5 days was 7% (95% CI, 3.4%-10.6%). No clinically or radiologically diagnosed pulmonary embolism occurred in patients with DVT. No independent risk factor associated with DVT was identified. Hospital mortality in those with and those without DVT was 42.9% and 32.3%, respectively. There was no significant difference in the length of ICU or hospital stay or inpatient mortality between those with and those without DVT. ConclusionWithout thromboprophylaxis, the incidence of DVT in the Thai population remains low. A strategy of screening ultrasound 5 to 7 days after admission to the ICU may be a suitable alternative to anticoagulant prophylaxis in critically ill Thai patients without symptoms of venous thromboembolism.

Effect of a seven-strain probiotic on dietary intake, inflammatory markers, and T-cells in severe traumatic brain injury patients: A randomized, double-blind, placebo-controlled trial.

Inflammatory processes are key factors in pathological events associated with severe traumatic brain injury (STBI). The aim of this trial was to determine the effect of probiotics on anthropometric measures, disease severity, inflammatory markers, and T cells in patients with STBI. Forty adult patients with STBI were enrolled in this parallel randomized, double-blind, placebo-controlled trial. Energy and protein status, Acute Physiology and Chronic Health Evaluation (APACHE II) score, Sequential Organ Failure Assessment (SOFA), interleukin 10 (IL-10), interleukin 1β (IL-1β), tumor necrosis factor-alpha (TNF-α), transforming growth factor beta (TGF-β), T-helper 17 (Th17), and T- Regulator (T-reg) cells were assessed at baseline (day 1), and week 2 (day 14) for each patient. Probiotic supplementation led to a substantial reduction in the serum levels of TNF-α (from 10.15 ± 6.52 to 5.05 ± 3.27) (P = 0.034), IL-1β (from 11.84 ± 7.74 to 5.87 ± 3.77) (P < 0.001), and Th17 cells (from 5.19 ± 1.69 to 2.67 ± 1.89) (P < 0.001) and a substantial increase in the serum levels of IL-10 (from 3.35 ± 1.45 to 6.17 ± 2.04) (P = 0.038), TGF-β (from 30.5 ± 15.27 to 46.25 ± 21.05) (P < 0.001), and T-reg cells (from 2.83 ± 1.43 to 4.29 ± 1.89) (P < 0.001) compared with the placebo group. Furthermore, no notable changes were observed in energy and protein intake and also, terms of SOFA and APACHE II scores following probiotic treatment compared with the placebo. Probiotics could reduce inflammation and improve cellular immunity and may be considered as an adjunctive therapy in STBI patients.

A Retrospective Comparison of Clinical and Laboratory Aspects of Patients With COVID-19-Related Acute Respiratory Distress Syndrome (ARDS) and Non-COVID-19-Related ARDS.

This study investigated demographic characteristics, hemodynamic values, respiratory datas, laboratory values ​​such as biochemistry and blood gas, and treatment approaches of coronavirus disease 2019 (COVID-19)-related and non-COVID-19-related acute respiratory distress syndrome (ARDS) patients hospitalized in the intensive care unit (ICU). Determining the differences and similarities between COVID-19-related ARDS (CARDS) patients and non-COVID-19-related ARDS (NCARDS) patients will be useful to better understand these two diseases. A total of 32 NCARDS patients who were followed and treated in the ICU for various reasons between January 2015 and December 2020 and 32 CARDS patients who were followed and treated in the ICU for various reasons between March 2020 and December 2020 were examined retrospectively. Age, gender, comorbidities, Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation (APACHE) II Score, blood pressure, heart rate, saturation, laboratory results, arterial blood gas (ABG) values, length of stay in the ICU, intubation, the number of days till the patient was extubated, the treatments applied, admission to the service, and mortality were evaluated. In the comparison between the two groups, the demographic data of the patients, the number of days intubated and extubated, APACHE II scores, and ICU length of stay were not statistically different. Values of positive end-expiratory pressure (PEEP), first hospitalization GCS, first hospitalization hemoglobin (Hgb), albumin at first admission, alanine aminotransferase (ALT) at first admission, and steroid use were found to be significantly different in patients with CARDS (p < 0.001). The median of PEEP values (p = 0.04), first admission GCS values (p = 0.04), first admission Hgb values (p = 0.005), albumin values at the first admission (p = 0.03), ALT values (p = 0.03), and the rate of steroid use (p = 0.001) of CARDS patients were significantly higher than those of NCARDS patients. The median of the first hospitalization heart rate values (p = 0.009), first hospitalization saturation values (p = 0.001), and first admission neutrophil values (p = 0.03) in NCARDS patients were significantly higher than that of CARDS patients. There was no significant difference between the two groups in terms of mortality, sedation use, inotropic support, C-reactive protein (CRP), and procalcitonin values. CARDS and NCARDS have clinical and laboratory similarities and differences. Therefore, there should be differences in our follow-up and treatment approach to these two disease groups.

Machine learning-based model to predict severe acute kidney injury after total aortic arch replacement for acute type A aortic dissection

BackgroundSevere acute kidney injury (AKI) after total aortic arch replacement (TAAR) is related to adverse outcomes in patients with acute type A aortic dissection (ATAAD). However, the early prediction of severe AKI remains a challenge. This study aimed to develop a novel model to predict severe AKI after TAAR in ATAAD patients using machine learning algorithms. MethodsA total of 572 ATAAD patients undergoing TAAR were enrolled in this retrospective study, and randomly divided into a training set (70 %) and a validation set (30 %). Lasso regression, support vector machine-recursive feature elimination and random forest algorithms were used to screen indicators for severe AKI (defined as AKI stage III) in the training set, respectively. Then the intersection indicators were selected to construct models through artificial neural network (ANN) and logistic regression. The AUC-ROC curve was employed to ascertain the prediction efficacy of the ANN and logistic regression models. ResultsThe incidence of severe AKI after TAAR was 22.9 % among ATAAD patients. The intersection predictors identified by different machine learning algorithms were baseline serum creatinine and ICU admission variables, including serum cystatin C, procalcitonin, aspartate transaminase, platelet, lactic dehydrogenase, urine N-acetyl-β-d-glucosidase and Acute Physiology and Chronic Health Evaluation II score. The ANN model showed a higher AUC-ROC than logistic regression (0.938 vs 0.908, p < 0.05). Furthermore, the ANN model could predict 89.1 % of severe AKI cases beforehand. In the validation set, the superior performance of the ANN model was further confirmed in terms of discrimination ability (AUC = 0.916), calibration curve analysis and decision curve analysis. ConclusionThis study developed a novel and reliable clinical prediction model for severe AKI after TAAR in ATAAD patients using machine learning algorithms. Importantly, the ANN model showed a higher predictive ability for severe AKI than logistic regression.

The Value of Serum Procalcitonin, Thromboelastography Combined with Platelet Count in Predicting the Short-Term Progression of Septic Shock in the Intensive Care Unit.

By evaluating the level of serum procalcitonin (PCT), thromboelastography (TEG) and platelet count (PLT) of patients with septic shock in intensive care unit (ICU), the predictive value of the combination of the three indicators on the short-term progression was discussed, which provided a new basis for early clinical diagnosis and disease evaluation. The clinical data of 130 patients with septic shock admitted to the IUC of our hospital from December 2021 to December 2023 were analyzed retrospectively. These subjects were divided into good prognosis group (n=78) and poor prognosis group (n=52) according to the 28 d deaths. The influencing factors were explored using the Multivariate logistic regression analysis. The value of single or combined PCT, PLT and TEG in predicting poor short-term prognosis was assessed using the receiver operating characteristic (ROC) curve. The patients in poor prognosis group had higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, serum PCT level, coagulation reaction time (R value) and coagulation formation time (K value), but lower PLT levels, final strength of coagulation (MA value) and coagulation formation rate (α angle) than those in good prognosis group (P<0.001). PCT, R value and K value were risk factors (P<0.001), while PLT, MA value and α angle were protective factors (P<0.001). The area under the curve (AUC) of PCT, PLT and TEG predicting poor short-term progression was 0.813, 0.658 and 0.752, respectively. The AUC of combined three indicators was 0.905, which had the highest predictive value. Serum levels of PCT, PLT and TEG had certain value in predicting poor short-term progression of septic shock patients, and their combined diagnostic value was higher. Therefore, regular monitoring of these three indicators could provide certain guiding significance for the prevention and treatment of poor short-term prognosis in patients with septic shock.

Dexmedetomidine for Reducing Mortality in Patients With Septic Shock A Randomized Controlled Trial (DecatSepsis)

Sepsis, especially septic shock, and its complications have been linked to the hyperadrenergic stress response. Does decatecholaminization with dexmedetomidine lower the in-hospital mortality in patients with septic shock? This open-label randomized controlled trial assessed the effects of a heart rate (HR)-calibrated dexmedetomidine infusion on in-hospital mortality in patients with septic shock and HR of > 90 beats/min, regardless of whether they are receiving mechanical ventilation. Dexmedetomidine was infused for 48h to maintain the HR at 60 to 90 beats/min. Mechanically ventilated patients received conventional sedation in both groups. Other outcomes were the norepinephrine equivalent dose, the need for additional vasopressor, Acute Physiology and Chronic Health Evaluation (APACHE) II score, persistent atrial fibrillation (AF), and C-reactive protein (CRP) level. In 90 patients of either sex, dexmedetomidine reduced the mean HR over the first 3days in the ICU by 11.2 beats/min (95%CI, -17 to -5 beats/min; P< .001). The in-hospital mortality risk ratio (RR) was 0.68 (95%CI, 0.43-1.07; P= .091). The dexmedetomidine group received a norepinephrine equivalent dose of 0.55 μm/kg/min (interquartile range [IQR], 0.37-0.82 μm/kg/min) vs0.61 μm/kg/min (IQR, 0.47-0.89 μm/kg/min; P= .121). Dexmedetomidine reduced the epinephrine infusion rescue (relative risk reduction, 0.6; 95%CI, 0.06-0.93; P= .025). The RR of persistent AF was 0.47 (95%CI, 0.21-0.99; P= .05). Dexmedetomidine reduced the median APACHE II score on the third day by -6 (95%CI, -10 to -2; P= .003) and the mean CRP concentration by -40mg/dL (95%CI, -78 to -3.4mg/dL; P= .033). The study was underpowered to detect a reduction in in-hospital mortality or norepinephrine equivalent dose in patients with septic shock with dexmedetomidine. However, dexmedetomidine may reduce epinephrine infusion rescue, persistent AF, the APACHE II score, and CRP. ClinicalTrials.gov; No.: NCT05283083; URL: www. gov.

Nutritional Prescription in ICU Patients: Does it Matter?

The nutritional status of the patients before critical illness and nutrition support given during the critical illness play an important role in the recovery. We aimed to evaluate the nutritional prescription and its effect on ICU mortality. This was a prospective observational study conducted after institutional ethical committee approval (IEC 94/2018, CTRI/2018/06/014625) in a case-mixed (medical and surgical) ICU. Patients admitted to the ICU were enrolled within 24 hours of admission. The amount of calories and proteins prescribed and received by the patients was collected for 7 days. The primary outcome was ICU mortality. A total of 100 patients were included. The mean age was 48.63 (16.25) years, and 62% were males. The acute physiology and chronic health evaluation (APACHE II), sequential organ failure assessment (SOFA), and modified Nutric (mNUTRIC) scores were comparable between the two groups. The ICU mortality was 30%. The calorie and protein deficits were comparable between survivors and non-survivors. Among the secondary outcomes, a significant time effect (p = 0.013) and interaction effect (p = 0.004) were noted for maximum glucose levels. The glucose variability calculated by coefficient of variation (CV) was significantly higher in non-survivors than survivors (p = 0.031). The calorie and protein deficits did not affect ICU mortality. The maximum glucose variability and CV were significant parameters associated with ICU mortality. Havaldar AA, Selvam S. Nutritional Prescription in ICU Patients: Does it Matter? Indian J Crit Care Med 2024;28(7):657-661.

Predictive value of plasma exosome count for the prognosis in septic patients

To investigate the predictive value of plasma exosome count for the prognosis of patients with sepsis. A prospective observational study was conducted. The patients with sepsis admitted to intensive care unit (ICU) of Zhejiang Hospital from November 2020 to December 2021 were enrolled as the study subjects. On the 1st day of admission to the ICU, the patient's gender, age, underlying disease, infection site, mean arterial pressure (MAP) and severity scores were recorded, and venous blood was taken for detecting the blood routine, blood biochemistry, and procalcitonin (PCT), and arterial blood was taken for blood gas analysis, simultaneously, the patient's noradrenaline (NA) dosage was recorded. On the 1st, 3rd, 5th, and 7th day of ICU admission, plasma exosomes were extracted, and the number of exosomes was detected by nanoparticle tracking analyzer. The endpoint of observation was the death of the patient 28 days after admission to the ICU. The differences in baseline data and plasma exosome counts of patients with different 28-day prognosis were analyzed and compared. The Spearman correlation method was used to analyze the correlation between plasma exosome counts and other clinical indicators. Binary multivariate Logistic regression analysis was used to screen the 28-day death risk factors of septic patients. The receiver operator characteristic curve (ROC curve) was plotted to analyze the predictive value of each index on the 28-day death of septic patients. The Kaplan-Meier method was used to analyze the 28-day survival curve. A total of 26 patients with sepsis were enrolled, of whom 21 survived and 5 died on the 28th day. Compared with the survival group, the patients in the death group had lower MAP, higher sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score, white blood cell count (WBC), cardiac troponin I (cTnI), and worse oxygenation. The plasma exosome count on the 1st day of ICU admission in the death group was significantly higher than that in the survival group (×1015/L: 16.96±9.11 vs. 5.20±2.42, P < 0.05). Subsequently, the plasma exosome counts in both groups continued to decrease, and there was no statistically significant difference between the two groups. Spearman correlation analysis showed that the plasma exosome count on the 1st day of ICU admission in septic patients was significantly positively correlated with SOFA score, APACHE II score, blood lactic acid (Lac), alanine aminotransferase (ALT) and NA dosage (r values were 0.572, 0.585, 0.463, 0.411, 0.696, all P < 0.05), and it significantly negatively correlated with MAP and oxygenation index (PaO2/FiO2; r values were -0.392 and -0.496, both P < 0.05). Multivariate Logistic regression analysis showed that plasma exosome count on the 1st day of ICU admission was an independent risk factor for 28-day death in septic patients [odds ratio (OR) = 1.385, 95% confidence interval (95%CI) was 1.075-1.785, P = 0.012]. ROC curve analysis showed that the area under the ROC curve (AUC) of plasma exosome count on the 1st day of ICU admission for predicting 28-day death in septic patients was 0.800 (95%CI was 0.449-1.000); when the optimal cut-off value was 14.50×1015/L, the sensitivity was 80.0% and the specificity was 100%. According to the optimal cut-off value of 1-day plasma exosome count, the patients were divided into two groups for Kaplan-Meier survival curve analysis, and the results showed that the cumulative survival rate of patients with plasma exosome count < 14.50×1015/L was significantly higher than that of patients with plasma exosome count ≥ 14.50×1015/L (Log-Rank test: χ 2 = 19.100, P < 0.001). The plasma exosome count of septic patients is significantly increased on the 1st day of admission to the ICU, which is related to the severity, and can predict the risk of death at 28 days.

Evaluation of post cardiopulmonary resuscitation patıents followed in intensive care unit: A one-year retrospective analysis.

Aim: Post Cardiopulmonary Resuscitation (CPR) patients are a critical patient group. Despite the development of treatment options and guidelines, mortality and morbidity rates in these patients are still high. We aimed to obtain a descriptive data for post CPR patients admitted to Intensive Care Unit (ICU). Material and Methods: This single-center, retrospective observational study was conducted in the mix ICU’s at the Karabuk University Hospital in Karabuk, Turkey, from Jan 2023 to Jan 2024. Demographic data of the post-CPR patients, Acute Physiology and Chronic Health Evaluation II (APACHE II) and Glasgow coma scores (GCS), length of stay in the ICU and mortality were recorded through our hospital database. Results: During the study period,78 patients were evaluated. The mean age of the patients was 75.01 ± 9.6 years, and 42 of them were female (53.84%). The mean APACHE II scores on ICU admission was 21.15 ± 7.2, and mean GKS was 8.29 ± 2.4. Comorbid disease was present in 96.15% of the patients, and 35 patients had 3 or more comorbid diseases. Twenty-six patients survived whereas 52 died in ICU. APACHE II scores and. the lactate level were higher, whereas GCS score was lower in nonsurvivors. Conclusion: High mortality rates have been reported for post CPR patients. There are many factors that have been suggested to be prognostic for these patients. In our died patients, the lactate level and their APACHE II score were higher and their GCS scores were lower.

Moral distress as a persistent risk factor for impaired mental health among healthcare workforce

BackgroundMoral distress among healthcare workers (HCWs) has dramatically increased during Covid-19 emergency however most evidence relies on cross-sectional data collected during Covid-19 early stages. AimsThis longitudinal cohort study aims to provide a better insight into the occurrence and associations of moral distress, focusing on both its short and long-term impact on HCWs’ mental health. MethodsA total of 990 healthcare workers completed a mental health evaluation between July 2020-July 2021 (Time 1) reporting frequencies of moral distress and psychological distress (GHQ-12), post-traumatic (IES-R) and anxiety (GAD-7) symptoms; after one year (July 2021-July 2022; Time 2), 310 participants repeated the psychological evaluation. We investigated differences considering socio-demographic and occupational characteristics. Two logistic regression models examined the potential role of moral distress as a risk factor for scorings above scales’ cut-offs at Time 1 and at Time 2. ResultsFrequent episodes of moral distress were mostly reported by nurses (24 %), physicians (22 %), younger workers (<40y; 23 %) and workers engaged in Covid-19 area; HCWs from Emergency/Intensive Care Departments reported the highest occurrence of moral distress (29 %). Results showed increases in all psychological symptoms as episodes of moral distress became more frequent. Moral distress experienced at Time 1 resulted as a persistent risk for mental health impairment in the following year, with stable ORs for post-traumatic symptoms (Time1 OR=7.8, 95 %CI=(5.3,11.6) and Time2 OR=6.6, 95 %CI=(2.9,15.7). ConclusionsOur findings support long-term consequences of moral distress; preventive strategies may be addressed with priority to younger HCWs and nurses/physicians from Emergency and Intensive Care Departments.